番茄社区

Pain and physical function improved significantly among disadvantaged patients after 10 weeks of simplified talk therapy, a randomized controlled trial found.

Pain intensity scores decreased substantially for low-income, chronic pain patients who received either group cognitive behavioral therapy (CBT) or pain education (EDU) compared with those who received usual care, reported Beverly Thorn, PhD, of the University of Alabama in Tuscaloosa, and colleagues.

And at 6 months, 21.7% of patients who received CBT and 16.4% who received EDU sustained improvement in pain intensity scores versus 8.5% of the usual care group, they wrote in the .

"This research established that providing a structured, directive skills-building approach with simplified patient workbooks and audio aides reduces self-reported pain and increases physical function over and above that provided by traditional biomedical care," Thorn said.

"Research had already shown that cognitive behavioral therapy and some types of pain education are effective for reducing pain and increasing function in people with chronic pain," she told 番茄社区. "We didn't know whether it could be simplified and used with a very disadvantaged population -- over 70% at or below poverty level, and over 35% reading below the fifth-grade reading level -- to help them with pain self-management."

Chronic pain low-income populations, which also have greater risk of pain-related disability. Clinical practice guidelines promote non-drug, evidence-based alternatives to manage pain, but access to treatments like CBT is limited, especially in poor communities.

In this three-group, parallel-design trial known as the LAMP (Learning About My Pain) study, researchers studied 290 chronic pain patients from four clinics in western Alabama, excluding patients with cancer-related pain, self-reported substance abuse, recent changes in pain or psychotropic medication, or current psychosocial treatment.

The average age of participants was about 52; 71 % were women, 67% were from racial or ethnic minority groups, 72% had an income at or below the poverty level, 36% read below the fifth-grade level, and 83% received or sought disability benefits.

The CBT group (n=95) received 10 weekly, 90-minute group sessions to learn simplified techniques and pain management skills like cognitive restructuring, activity pacing, and relaxation.

The EDU group (n=97) also received pain self-management information and 10 weekly, 90-minute group sessions, but no specific skill-building exercises. The usual care group (n=98) had contact with patient coordinators and assessors, but no psychosocial treatment.

The researchers adapted the CBT and EDU interventions from previous research, simplifying treatment procedures and revising patient workbooks to a fifth-grade reading level. All participants received usual medical care, including medication, chiropractic, or physical therapy.

Blinded assessors conducted 90-minute interviews with patients at baseline and at 5 weeks, 10 weeks, and 6 months after treatment started. Patients were paid $45 for each assessment.

On average, patients reported more than six distinct pain sites, more than four causes of pain, and pain lasting longer than 15 years. Their average pain intensity and physical functioning was moderately severe at baseline.

Over time, the usual care group showed no change in pain intensity scores. At 10 weeks, CBT and EDU had larger decreases in pain intensity scores than usual care:

• CBT: -0.80 estimated difference was (95% CI -1.48 to -0.11, P=0.022)
• EDU: -0.57 (95% CI -1.04 to -0.10, P=0.018)

The proportion of participants with a 30% or greater improvement in pain intensity scores was 30.5% for CBT, 20.0% for EDU, and 11.5% for usual care 10 weeks after treatment started.

At 6 months, more participants in the CBT (21.7%) and EDU (16.4%) groups still had a 30% or greater improvement in pain intensity scores than the usual care (8.5%) group. While treatment gains were not maintained in the CBT group, they still were present for EDU patients.

Participants in the CBT and EDU interventions also had greater post-treatment improvement in physical function than the usual care group, and this progress was maintained at 6 months.

"This study is important because it heeds the call from the [now called the National Academy of Medicine], as well as the authors of the U.S. Department of Health and Human Services (HHS) , to address the widely observed social determinants of chronic pain and to execute strategies to resolve disparities in pain treatment,' wrote Robert Kerns, PhD, of the Yale School of Medicine in New Haven, Connecticut, in an .

"From the LAMP study, we learned that an engaged healthcare organization and staff, small financial incentives for patient travel, and a patient-centered approach to service delivery can overcome at least some of the known barriers to accessing and participating in this effective psychological intervention," he stated.

Study limitations included the enrollment of patients in a single healthcare system with limited resources. Also, self-selection bias may have occurred. Patients had mixed chronic pain conditions so researchers could not discern whether treatment response differed by pain type. They also could not document whether changes in opioid use happened as a result of the intervention.